Section 8: Dietary Management

Dietary Therapy Goals and Management

In cats diagnosed with DM, dietary therapy is typically considered a complement to insulin or SGLT2 inhibitor use. Occasionally cats will successfully go into remission with a diet change, but this is not to be expected. However, diet modification and achieving an ideal body weight may be helpful in reducing DM risk in non-diabetic obese cats or subclinical hyperglycemic cats. Consider a diabetic patient’s individual needs when making a nutritional recommendation.

Dietary therapy aims to optimize body weight with appropriate macronutrient levels and calorie and portion control. Treatment goals include weight loss in obese patients and stopping DM-associated weight loss. Dietary management of DM involves the following:

• Calculate daily caloric intake based on optimized body weight and an accurate diet history.
• Monitor body weight (using the same scale for consistency) at least once or twice monthly as therapy is instituted; a healthy rate of loss for an obese cat is 0.5–2% of body weight per week (see the AAHA Nutrition and Weight Management Guidelines at aaha.org for additional resources).
• Monitor body and muscle condition scores to help direct adjustments in dietary therapy.
• Manage protein and carbohydrate intake to minimize postprandial hyperglycemia. Protein normalizes fat metabolism and provides a consistent energy source. Arginine stimulates insulin secretion.
• Prioritize a patient’s reliable food intake from a complete and balanced diet over modifying specific nutrients.
• Adjust dietary recommendations if cats have concurrent diseases (e.g., chronic kidney disease, pancreatitis, intestinal disease). In these situations, the task force generally recommends selecting a diet based on which comorbidity is most likely to impact the patient’s survival, e.g., selecting a renal diet rather than a diabetic diet in a cat with both DM and advanced stage proteinuric renal disease. Consultation with a veterinary nutritionist can be helpful in formulating nutritional plans that work for multiple comorbid conditions.

It is ideal to use meal feeding with intermediate-acting insulins that peak within a few hours of injection; however, this is not essential in cats and graze eating over the day is acceptable. With glargine U-300, strict meal feeding is not required because the frequency of injections may be decreased and risk of hypoglycemia associated with missed meals is low.¹ The timing of meals can also be adjusted if the pet is eating a low–glycemic index diet.²

• Feeding portioned meals has several advantages for the dietary management of diabetic cats:
  • It is easier to monitor intake and appetite.
  • Portion control is facilitated.
• Free-choice feeding is acceptable if a cat’s eating habits cannot be changed. (The task force recommends the daily ration be divided into multiple meals. Timed feeders may help in this scenario.)³
• Canned foods are preferred over dry foods. Canned foods provide:
  • Lower carbohydrate levels.
  • Ease of portion control.
  • Lower caloric density; cats can eat a higher volume of canned food and obtain the same caloric intake as smaller volumes of dry food.
  • Additional water intake.

Commercially available therapeutic diets designed for diabetic cats are often calorie dense. For obese cats (BCS >7/9), feeding a diet with moderate carbohydrate content (15-25% metabolizable energy [ME]) and lower calories, such as a therapeutic diet designed for weight loss, may be considered.⁴

The ideal diet for most diabetic cats includes:⁵

• High protein content (>40–45% ME, >10 g/100 kcal) and reduced carbohydrate content(<12–15% ME, <3 g/100 kcal)⁶
• Canned food or a mix of canned and dry⁷
• Carbohydrate intake should be limited because carbohydrates may contribute to hyperglycemia and glucose toxicity. The task force recommends a diet carbohydrate content of ~12% ME, recognizing that there are a variety of expert opinions on this topic.^8,9
• Diabetic cats have reported remission rates between 15 and 100% when given a combination of a high-protein/low-carbohydrate diet and insulin.^10,11
• High-fiber diets are not typically recommended for cats with DM.

Pet food labels do not consistently include carbohydrates in the guaranteed analysis, although The American Association of Feed Control Officials Pet Food Label Modernization regulations require carbohydrates (see www.aafco.org/pflm/). If not listed, the carbohydrate content of a diet can be calculated by subtracting the listed percentages of protein, fat, fiber, moisture, and ash from 100. If ash content is also not listed, use an estimate of 2-3% for canned diets and 5-8% for dry diets. Then, online tools can be used to convert nutrient information to ME. Balance.it has a free guaranteed analysis to ME content of nutrients converter (balance.it/convert), and Tufts University also has a nutrient converter (sites.tufts.edu/petfoodology/2017/08/07/nutrient_converter/).

The 2026 AAHA Diabetes Management Guidelines for Cats are generously supported by Adapet Medical, Boehringer Ingelheim, Dechra, and Merck Animal Health.